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Embedding lay health educators in family physicians’ offices may have the potential to improve cancer screening rates among South Asians living in Peel Region, according to a small new study.

Four family physicians embedded lay health educators, or “health ambassadors,” in their practices in the hopes of improving cancer screening for their South Asian patients, according to a pilot study published today in Patient Preference and Adherence.

The health ambassadors were volunteers with the Canadian Cancer Society’s Screening Saves Lives program. They were all of South Asian ethnicity and had participated in a four-session training program. Most health ambassadors were foreign-trained physicians who were not practicing medicine in Canada, but some were non-physician members of the South Asian community with strong social networks. They were trained by the Cancer Society to share screening messages with their peers and social networks.

Peel Region – a Toronto-area regional municipality of Brampton, Caledon and Mississauga – has 1.3 million residents, nearly one-quarter of whom are of South Asian ethnicity. South Asians are the largest and fastest growing visible minority group in Canada.

Previous research by Dr. Aisha Lofters, a family physician with the St. Michael’s Academic Family Health Team and lead author of the study, has found South Asians living in Peel Region are less likely than other Ontarians to be screened for breast, cervical or colorectal cancer, making them much more vulnerable to cancer deaths.

“Despite having generally good access to primary care, and better access than many other immigrant groups, South Asians in Ontario appear to be the most under-screened group for all three of these cancers,” said Dr. Lofters.

“Ontario has organized screening programs for these three cancers, but cancer screening is still fundamentally embedded in primary care, suggesting that primary care providers could be the key to addressing under-screening for South Asian patients.”

For all four physicians, approximately 60 per cent of South Asian patients who were overdue for cancer screening and who spoke directly to health ambassadors stated they were willing to be screened.

However, patients expressing willingness to be screened did not necessarily equate to patients actually getting screened, and the capacity for these physicians to track screening was limited, according to the authors.

For three physicians’ practices, researchers were unable to determine how many patients actually went on to be screened. Tracking actual screening uptake among individual patients was resource-intensive, raised issues around data privacy, and was ultimately only feasible in one office, the authors wrote.

In one practice, patients who were contacted by patient navigators and spoken to in their own languages had significantly higher screening rates for breast, cervical and colorectal cancer screening over eight months (23.4 per cent, 14.4 per cent and 13.7 per cent respectively).

Although the immediate costs of embedding lay health educators were very low, the sustainability of volunteer-led initiatives remains a challenge. The Health Ambassadors had other competing duties, and could not visit a particular clinic more than a few hours per week, limiting the ability to reach a larger number of patients within each office.

Making phone calls to patients to invite them for screening had the most reach and the most appeal for participating physicians, according to the study, but the majority of patients were not able to be reached directly by telephone. Health ambassadors also noted that patients could be suspicious on the telephone of who they were, how they had obtained their contact information, and how they were affiliated with the physicians’ offices.

The final challenge was that researchers have no details about the demographics of patients who were approached. Factors such as education level, socioeconomic status and years in Canada could all affect willingness to screen, but researchers were unable to track those variables in this study.

Despite these challenges, all physicians had positive views of working with the health ambassadors, and three of four physicians planned to continue to work with lay educators, said Dr. Lofters.

“It was a small sample, and there is definitely a need for more research into how best to implement the health ambassadors initiative, but the research clearly demonstrates that these initiatives could positively impact cancer screening rates and improve health outcomes for South Asians in Ontario,” she said.

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

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